A conversation with Prof Carel le Roux

Professor Carel le Roux graduated from medical school in Pretoria South Africa,

completed his specialist training in metabolic medicine at St Bartholomew’s Hospitals

and the Hammersmith Hospitals, his PhD at Imperial College London and was later

promoted to Reader. He moved to University College Dublin for the Chair in

Pathology and he is now the Co-Director of the Metabolic Medicine Group. He

previously received a President of Ireland Young Researcher Award, Clinician

Scientist Award from the National Institute Health Research in the UK, a Wellcome

Trust Clinical Research Fellowship for his work on how the gut talks to the brain.

Q:Being from South Africa, what is your opinion on South Africa’s current obesity crisis?

A: The obesity crisis in South Africa is of major concern at the moment. What we are seeing is that patients are really suffering with the disease and yet we don't have the long term solutions for most patients, therefore many people are coming to harm and are having diseases that are not only killing them earlier but also driving down their quality of life . What we are trying to achieve is a personalized medicine approach where we have the right treatment for the right patient at the right time and that remains a challenge.

Q: From your talk it became apparent that obesity is an individualistic experience which is different for each person. This seems to be quite a recent development - how do you see this impacting treatment offered by South African doctors in the field?

A: South African doctors are incredibly well trained and have a wealth of experience. What we are finding now is that the tools are being developed and some of those tools can be dietary ,some of them are medication and some of them are surgical - what we are trying to do is work out which patients will benefit from which treatment . What we do understand is that certain treatments are better at providing long-term weight loss solutions than others and it's the amount of weight loss achieved that really determines the benefit on many of the diseases. If ,for example, you need 25% weight loss to make your sleep apnoea better or put your diabetes in remission or to improve your fatty liver disease then surgical treatments are by far superior to any diet or medication that we have at the moment .

Q: How important do you feel Congresses like this one are to the development of international medicine ?

A: Congresses - especially international congresses- allow people to come together and share thoughts. We are at the beginning of understanding all of medicine and therefore we need our opportunity to exchange ideas. More so, we also need the opportunity to be able to disagree with each other and to challenge the science that is being presented because only that way are we going to be able to make any significant progress.

Q: What is your opinion on the current stigmas surrounding obesity and the difficulties of losing weight?

A: I think the stigmas surrounding weight loss at present are driven predominantly through ignorance surrounding the disease. Once people understand that obesity is a disease in a very similar way to any other disease then the stigma will reduce. That is what we did with type 2 diabetes 25 years ago when people did not think it was a real disease but we now understand that type 2 diabetes is a chronic and progressive disease and we can treat it .This makes a difference and therefore the stigma has been reduced surrounding diabetes. We also see the stigmas reduced about other chronic disease like HIV ,for example, and we need to understand that obesity is a disease of the part of the brain that you and I cannot change by thinking. Therefore you don't have to be a better citizen to have a response - all you need to do is follow the messages that come from the part of the brain that control our hunger and satiety. Making that switch really opens people's eyes and allows us to treat this as a chronic disease which of course will then relate to better outcome for our patients.

Q:Could you perhaps explain what you are currently working on?

A: My current work focuses on how we can actually allow people to feel less hungry and more satisfied and how we can translate that benefit and change in symptoms to a long-term reduction of the the complications of obesity . We want to understand not only how can we reverse type 2 diabetes or put type 2 diabetes into remission but even how can we put the complications of type 2 diabetes, such as chronic kidney disease, into remission and i think we are going to be able to achieve this in the shorter term because we have so many tools that are developing. However, we also we need to be able to use our existing tools in a better way.

Q:You lead a campaign called “It’s Not Your Fault”. Could you please elaborate on that for us?

A: We created a campaign called “It’s Not Your Fault” and a website called itsnotyourfault.ie (referring to Ireland) and really the reason for this was that we found that by patients understanding that the chronic disease of obesity is not their fault and they have not deserved anything to have this disease allows them to seek treatment . If we have a disease - if you develop epilepsy today, you are not going to think that it’s your fault and it is easy for you to go to a doctor and ask for help , but if you have a disease such as type 2 diabetes or even if you have a disease such as obesity and you think this disease is your fault you will be more hesitant to seek seek help. By not seeking help we can't treat you. The treatment may be diet, exercise, medication or surgery but it allows us to connect our patients diagnose them and find the best treatment for them.

Q:What steps do you believe the government should be taking to combat conditions like obesity and diabetes?

A: The South African government can play an incredibly important role in helping us treat the condition and disease of obesity and the way they can help is by stopping the discrimination that citizens of the country suffer because of a disease that is not their fault . It is not acceptable to discriminate against people because of a disease and it is not acceptable to discriminate against people because of the disease of obesity. Now, many other diseases in the past could not be treated immediately but we knew that it is not only cruel and inhumane to discriminate against people but it is also wrong and, therefore, we are in a position where it is tough to treat a chronic disease such as obesity and our tools are not yet fully developed. The government needs to make it very clear that it is not acceptable to discriminate against people. This will allow us to bring more people into treatment options and again the treatment options may include diet ,exercise, medication or surgical means but regardless of which treatment option an individual needs they must be afforded the respect and opportunity to pursue said treatment.

Q: If you could say one thing to somebody battling obesity at this moment, what would it be?

A: I would say this disease is not your fault but you have a responsibility to find a treatment that will allow you to become healthier because there's a massive amount of health to be gained by intentional weight loss. Find a treatment that works and understand that it's not your fault but also understand your responsibility in the system of effective treatment.

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